Drug expert emphasises the problems with legal drugs

World expert on drug and alcohol abuse Professor Michael Farrell drew attention to the serious impact of legal drugs on Australian society when he spoke at Warrane on Wednesday 16 April 2014.

The Director of the National Drug and Alcohol Research Centre (NDARC), and long-standing member of the Expert Committee on Drug and Alcohol Dependence of the World Health Organisation (WHO), said that around the world there were 2 billion alcohol users and 1.3 billion smokers, but only 185 million illicit drug users.

“If you talk about these things you would swear that everything was about illicit drug use,” Professor Farrell said, “but the biggest burden of health is tobacco, then alcohol and then illicit drug taking,”

While injecting drugs were a serious problem, the problems with legal drug abuse were more widespread. More was being done today to deal with the problem than in the past.

“An example of the difference in approach 20 to 30 years ago is that half of you would have been smoking,” he said. “We knew how dangerous it was but weren’t doing anything about it.”

With smoking there is now a range of public health and social policies, including making smoking more expensive, making cigarettes slightly harder to get and requiring smokers to go outdoors to smoke.

Regarding alcohol abuse, Professor Farrell pointed out that dependence was transmitted across generations and was widespread. “In any group I talk to about a quarter of the room will have had contact with serious alcohol problems,” he said, “either in their immediate family or across their extended family.

“These are not strange conditions that happen to strange people. They happen in the heart of a family and carry a huge burden of harm to others.”

One significant factor where drug abuse was concerned was religious observance.

“Those who are engaged in religious observance and regular church are far less likely to be involved in a range of problems,” Professor Farrell said.

It was also important to interpret the research carefully. For instance it was possible that family meals were also protective against drug abuse, but that may be an indicator that families that still ate together had not disintegrated into a serious level of disorganisation. But in general, highly functional families were highly protective against drug abuse. While some people got into trouble very soon after they engaged in alcohol, others could drink for many years before developing problems. The problems didn’t come on their own but were linked to things like other problems in the family, including sexual abuse.

In cases where there was a great deal of disruption within the family over the first 10 to 15 years of a person’s life, by young adulthood the person could be highly traumatised and then turn to drugs as a way of self medicating.

“That is the severe end of the spectrum,” Professor Farrell said. He cautioned that it was important with drug abuse to avoid being alarmist. Rather than promoting propaganda, it was necessary to stick to “the honest truth”. If the harms of drug use were exaggerated there was a danger that young people would “stop believing anything about harms”.

One example was the risk of cannabis use causing psychosis. “It took a long time for us to get really clear about the harms,” he said. “If you have a family history of schizophrenia (and used cannabis) you are at increased risk. The actual overall risk in those terms is actually quite modest but for those that it occurs to it is a pretty devastating effect.

“For younger people in developmental terms cannabis use is associated with educational marginalisation, poor performance in school and falling out of the mainstream of education. The argument has been that, well that is not really an effect of the drug, that is just the people who are doing it. But we have done enough work on that now to be pretty clear that that is a clear effect in its own right.

“And in terms of development, failing to benefit from your period of exposure to education is a really bad effect and that is probably the most simple and robust effect around cannabis.”

Other points Professor Farrell made included:

Jailing drug abusers was not necessarily the answer. While it appeared there was “not much sense putting people in prison for consuming drugs”, there was also the challenge of de-penalising something without commercialising it.

Raising the price of alcohol to discourage abuse was not a complete answer. “One of the things we say is that changing the price of alcohol can change long-term consumption, but the data we have looked at doesn’t convince us that it changes binge drinking because when people decide to go out and hammer it they are not necessarily saying ‘I have got this amount of money so therefore I am stopping’. So some of the binge drinking isn’t amenable to pricing manipulation but it is obviously amenable to access to the substance.”

Instead of being preoccupied with cannabis and the brain, society should be “far more concerned” about alcohol which had a serious impact on the brain, particularly on the frontal lobe. “Neuroscience shows brains actually continue to develop up to age of 30 particularly the frontal lobe which allows forward planning.”

Professor Farrell said nicotine and heroin were at the top of what he would call “stickiness”.

“That means if you use either nicotine or heroin you have a one-in-two chance of becoming a regular user,” he said. “With alcohol and cannabis use on a semi-regular basis you have between seven to ten percent chance of it becoming a daily habit.

“That means that the drugs have characteristics, the individuals consuming them have characteristics, and they interact and that is how you end up with a constellation of problems.”